Diso D, Venuta F, Anile M, De Giacomo T, Ruberto F, Pugliese F, Francioni F, Ricella C, Liparulo V, Rolla M, Russo E, Rendina E A, Coloni G F
Department of Thoracic Surgery, University of Rome, La Sapienza, V le del Policlinico 155, 00161 Rome, Italy.
Transplant Proc. 2010 May;42(4):1281-2. doi: 10.1016/j.transproceed.2010.03.114.
Lung transplantation (LT) represents the only available therapy for selected patients affected by end-stage pulmonary disease. Cardiopulmonary bypass (CPBP) is used, when required, during single and sequential double lung transplantation; however, it increases the risk of bleeding, early graft dysfunction, failure, and other potential side effects. We report our experience with 145 patients who underwent lung transplantations, among whom 34 required intraoperative CPBP. The indications for LT among these 34 patients were cystic fibrosis (n = 22), chronic obstructive pulmonary disease (n = 3), bronchiectasis (n = 2), primary pulmonary hypertension (n = 1), fibrosis (n = 2), pulmonary microlithiasis (n = 1), and retransplantation for obliterative bronchilitis (n = 3). CPBP was planned in 12 cases (group I) and unplanned in 22 (group II). The main reason for planning CPBP was primary and secondary pulmonary hypertension (mean pulmonary artery pressure >or=25 mm Hg). Acute right ventricular failure, hemodynamic instability, arterial desaturation, and increased pulmonary artery pressure were mandatory for unplanned CPBP. Among the 34 CPBP patients, the 30-day mortality rate was 35% (12/34) including 9 (70%) in group II (unplanned CPBP). The leading cause of death was multiorgan failure. The 1-year survival rates were 67% and 36%, and the 3-year survival rates were 47% and 18% for groups I and II, respectively. In conclusion, even if it represents a useful tool in the management of critical events, the use of unscheduled CPBP during LT procedures is associated with an increased postoperative morbidity and mortality.
肺移植（LT）是终末期肺病患者唯一可行的治疗方法。在单肺移植和序贯双肺移植过程中，必要时会使用体外循环（CPBP）；然而，这会增加出血、早期移植物功能障碍、衰竭及其他潜在副作用的风险。我们报告了145例接受肺移植患者的经验，其中34例术中需要CPBP。这34例患者的肺移植适应证包括囊性纤维化（n = 22）、慢性阻塞性肺疾病（n = 3）、支气管扩张症（n = 2）、原发性肺动脉高压（n = 1）、纤维化（n = 2）、肺微石症（n = 1）以及闭塞性细支气管炎再次移植（n = 3）。12例（I组）CPBP是计划内的，22例（II组）是计划外的。计划使用CPBP的主要原因是原发性和继发性肺动脉高压（平均肺动脉压≥25 mmHg）。计划外CPBP的必要条件是急性右心室衰竭、血流动力学不稳定、动脉血氧饱和度降低和肺动脉压升高。在34例接受CPBP的患者中，30天死亡率为35%（12/34），其中II组（计划外CPBP）有9例（70%）。主要死亡原因是多器官功能衰竭。I组和II组的1年生存率分别为67%和36%，3年生存率分别为47%和18%。总之，即使CPBP在危急情况处理中是一种有用的工具，但在肺移植手术中使用非计划的CPBP会增加术后发病率和死亡率。
